460. The Clinical Burden Associated with Zygomycosis-Related Hospitalizations in the US
Session: Poster Abstract Session: Mucor, Fusarium, and other Filamentous Mycoses
Thursday, October 8, 2015
Room: Poster Hall
Background: Zygomycosis is a fungal infection primarily affecting patients (pts) with diabetes and chronic immunocompromised states. The infection is rare, but due to rapid disease progression and high mortality, identification and management needs to be swift and effective. Analyses from over two decades ago estimated that 0.13 per 10000 discharges among US adults were affected by zygomycosis, but evidence suggests that the prevalence of infection is rising due to the increase in immunosuppression. This study assessed the clinical burden associated with zygomycosis including the prevalence, treatment patterns, length of stay (LOS), and rehospitalizations.

Methods: The Premier Perspective Comparative Database (PPCD), a US database with inpatient and hospital-affiliated outpatient data, was used to assess the clinical impact of zygomycosis (2005-2014). Hospitalizations with zygomycosis were identified by requiring the presence of the ICD-9 code 117.7 (inclusive of mucormycosis and phycomycosis) and/or microbiology diagnosis. Among patients with evidence suggestive of zygomycosis, prevalence estimates were then assessed for patients with and without evidence of ampothericin B and/or posaconazole utilization.

Results: A total of 775 inpatient visits were identified between 2005 and 2014 with an estimated prevalence (mean (range)) of 0.16 (0.12-0.20) per 10000 discharges. After the antifungal drug use criteria was applied, the number of visits were reduced to 555 with an estimated prevalence of 0.12 (0.09-0.17) per 10000 discharges. Among the 555 zygomycosis hospitalizations, 547 were identified via ICD-9 diagnosis code, 3 were a combination of ICD-9 code and microbiology data, and 5 were microbiology only. The mean patient age was 51.7 years and 63% were male.  Lipid formulations of amphotericin B were the most commonly used antifungal (62%). The mean (SD) LOS was 26 (29) days with a mortality rate of 23% (defined using discharge state as expired). One-month all-cause readmission rate was 30% and the 3-month readmission rate was 37%.

Conclusion: Findings suggest up to a 23% increase in zygomycosis encounters over the past two decades. Additionally, the extensive healthcare utilization as reflected by hospital length of stay and increased risk for any readmission should be considered.

Hongbo Yang, PhD1, Jinlin Song, PhD1, Chelsey Yang, BA1, Sneha Kelkar, MPH1, Edward Lee, PharmD2, Alan Fan, PhD2, Nkechi Azie, MD2, James Spalding, PharmD, MS, MBA2 and Dimitrios Kontoyiannis, MD, ScD, FACP, FIDSA3, (1)Analysis Group, Boston, MA, (2)Astellas Pharma Global Development, Inc., Northbrook, IL, (3)The University of Texas M.D. Anderson Cancer Center, Houston, TX

Disclosures:

H. Yang, None

J. Song, None

C. Yang, None

S. Kelkar, None

E. Lee, Astellas: Employee , Salary

A. Fan, Astellas: Employee , Salary

N. Azie, Astellas: Employee , Salary

J. Spalding, Astellas: Employee , Salary

D. Kontoyiannis, Merck: Consultant , Investigator and Scientific Advisor , Consulting fee , Research support and Speaker honorarium
Astellas: Consultant and Investigator , Consulting fee , Research support and Speaker honorarium
Pfizer: Consultant and Investigator , Research support and Speaker honorarium
FRG: Consultant , Consulting fee
Mylan: Speaker's Bureau , Speaker honorarium
Gilead: Speaker's Bureau , Speaker honorarium

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.